Finals MCQs-Mar 2014

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Finals Black Bank


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Many thanks to everyone who organised and collaborated to remember the questions on this paper - a very high percent of the questions were recalled - a HUGE effort by all.

  • There are only 30+ missing MCQs in the numbered section (and one Q was remembered at 2 different numbers)
  • There are 11 MCQs remembered but without recollection of the number. These are listed at the end of the numbered question section; these represent 11 of the missing ones
  • There are some questions with several remembered versions and all these versions are included.


1. Given the following diagram, what does X represent?

[three container chest drain diagram] (Question 1 had the picture of the three container chest drain, with the suction limiting outlet the answer to the question)

A. Amount of drainage since system was connected to patient
B. Level of resistance to drainage of pleural cavityMaximum pressure against the pleural cavity on expiration
C. Level of underwater seal applied to pleural cavity
D. Maximum pressure in pleural cavity on expiration
E. Maximum suction that can be applied to pleural cavity.

2. RH28 Retrobulbar block. Sign of brainstem spread

A. Atonic pupil
B. Unilateral blindness in blocked eye
C. Contralateral blindness
D. Diplopia- past papers remembered this as dysphagia
E. Nystagmus

(Question 2 was a repeat but with different options)

2. RH28 Retrobulbar eye block, what sign of blocking brain stem:

A. blocked eye blind
B. contralateral eye blind
C. nystagmus
D. diplopia

3. Something like: Otherwise healthy 20 yo male undergoes surgery for an ORIF tibia for open tib fracture. The limb is exanguinated and the tourniquet correctly applied at 250mmHg. His SBP is 120. When the surgeons go to start there is a small amount of bleeding. Do you..

A. Accept that a small amount of bleeding may occur with a tourniquet
B. Reinflate at a higher pressure
C. Check coags
D. Take tourniquet down, rexanguinate and reinflate
E. Something else

Tourniquet question: ORIF tib/fib fracture. BP was 110/70. Tourniquet correctly applied at 250 mmHg. Options were:

A. Reinflate at a higher pressure
B. Deflate, re-exanguinate and reinflate
C. Accept that there will be a small amount of bleeding
D. ?
E. ?

4. This was the CXR showing a widened mediastinum with an otherwise normal CXR, there was an electronic circuit thing at the bottom right but nothing else obvious. Aortic dissection was the answer (at least I think!)

5. [New] Minimum Fatigue caused by night time shift work is best achieved by

A. Avoiding sleeping before the shift
B. Avoiding sunlight.
C. Napping briefly during shift
D. Using benzodiazepines to assist sleeping
E. Using caffeine and other stimulants to stay awake

Answer B

5. Fatigue during night shifts can be minimized by:

A. Avoiding daylight
B. not sleeping during day
C short naps during shift
D use of caffeine or stimulants
E. using benzodiazepines for sleep during the day

5. To manage fatigue during night shifts you should-

A. Take caffeine or other stimulants
B. Take regular naps during shift
C. Do not sleep before shift ? or sleep before shift?

6. [OLD from Apr08] You are anaesthetising a patient who suffers from acute intermittent Porphyria for abdominal surgery. You wish to administer antiemetic. Most likely to precipitate acute attack of this disorder

A. Metoclopramide
B. Prochlorperazine
C. Tropisetron
D. Ondansetron
E. Droperidol

Answer A -- OHA 3ed pp212

7. A 65 year old man having a total hip placement under general anaesthetic has continued to take his moclobemide. He becomes hypotensive shortly after induction. The best treatment would be judicious use of

A. adrenaline
B. dobutamine
C. ephedrine
D. metaraminol
E. phenylephrine

7. Patient with depression for surgery forgets to omit his moclobemide, which agent would be BEST with hypotension under anaesthesia?

A. Noradrenaline
B. Adrenaline
C. Ephedrine
D. Metaraminol
E. Phenylephrine

8. EM52 The following capnography trace was observed in an intubated and ventilated patient. The most likely explanation for this respiratory pattern is

A. endobronchial intubation
B. endotracheal cuff leak
C. gas sampling line leak
D. obstructive airways disease
E. spontaneous ventilatory effort

8. EM52 Stem specifically asked about what would cause this waveform pattern in an intubated and ventilated patient. The capnograph trace looked like this: [diagram] Options were:

B. Leaking gas sampling line
C. Leaking endotracheal tube (?cuff)
D. Endobronchial intubation
E. Spontaneous ventilation

There was no single lung transplant or mainstem obstruction in the options.

The shape I've drawn is near accurate, with phase III at 20mmHg, and a big phase IV, I agonised over this question.

Also, which was less evident on the MCQ (because the lines were thick), is the long phase I after the two waves. Maybe the answer was to do with the long phase I.

[1]Diagram 1 of this website. The answer was a leaking gas sampling line.

9. When topping up a labour ward epidural to an epidural for lower segment caesarean section, the optimum level of block when assessed for light touch is to:

A. T2
B. T4
C. T6
D. T8
E. T11

10. You are in the pre-admission clinic assessing a 60 year old male who is due to undergo total knee replacement in 10 days time. He is taking Dabigatran 150mg BD for chronic atrial fibrillation. He has no other past medical history and normal renal function. He is planned for a spinal anaesthetic. The most appropriate management for his anticoagulation is:

A. Cease dabigatran 7 days prior
B. Cease dabigatran 3 days prior
C. Cease dabigatran 3 days prior and give bridging anticoagulation with enoxaparin
D. Cease dabigatran 24 hours prior and measure INR on day of surgery
E. Continue dabigatran and withhold on day of surgery

11. A 15 yo girl with newly diagnosed mediastinal mass presents for supra-clavicular lymph node biopsy under GA. The most important investigation to perform pre-operativel

B. CT chest
C. MRI chest
D. PET scan

12. A CTG recording with late prolonged decelerations. Cause:

B. Head compression
C. Uteroplacental insufficiency
D. Acute asphyxia
E. Umbilical cord compression.

13. A new antiemetic decreases the incidence of PONV by 33% compared with conventional treatment. 8% who receive the new treatment still experience PONV. The no of patients who must receive the new treatment instead of the conventional before 1 extra patient will benefit is

A. 3
B. 4
C. 8
D. 25
E. 33

14. You are anaethetising a lady for elective laparoscopic cholecystectomy, who apparently had an anaphylactic reaction to rocuronium in her last anaesthetic. There has not been sufficient time for her to undergo cross-reactivity testing. What would be the most appropriate drug to use:

A. vecuronium
B. cisatracurium
C. pancuronium
D. atracurium
E. suxamethonium

15. Increase in period bleeding EXCEPT

A. Gingko
B. Garlic
C. Ginger
D. Fish Oil
E. Echinacea

15. What herbal medicine does not increase bleeding (garlic, fish oil, ginko bilboa, ecinachea)

16. Post op hip ORIF, commonest periop complication

B. fat emboli
C. Delirium
E. Pneumonia

17. You are anaesthetizing a 50 year old man who is undergoing liver resection for removal of metastatic carcinoid tumour. He has persistent intraoperative hypotension despite fluid resuscitation and intravenous octreotide 50 ug. The treatment most likely to be effective in correcting the hypotension is:

A. Adrenaline
B. Dobutamine
C. Levosimenden
D. Milrinone
E. Vasopressin

18. 80 year old female for open reduction and internal fixation of a fractured neck of femur. Fit and well. You notice a systolic murmur on examination. Blood pressure normal. On transthoracic echo, she has a calcified aortic valve, with aortic stenosis with a mean gradient of 40mmHg. How do you manage her:

A. Instigate low dose beta blockade
B. Defer, and refer to a cardiologist
C. Perform a transoesophageal echo to get a better look at the valve
D. Proceed to surgery with no further investigation
E. Perform a dobutamine stress echo

19 (Repeat) Electrocardiogram in the Cs5 configuration. What are you looking at when monitoring lead I.

A. anterior ischaemia
B. atrial
C. inferior
D. lateral
E. septal

20. (Repeat) Pringles procedure for life threatening liver haemorrhage includes clamping of:

A. Aorta
B. Hepatic artery
C. Hepatic vein
D. Portal pedicle
E. Splenic Artery

21. A 60 y.o. diabetic man has below knee amputation for ischaemic leg. His neuropathic pain is treated with oxycodone 40mg BD and paracetamol 1g QID. He is also on omeprazole 20mg BD for reflux. You decide to start him on gabapentin. Before choosing a dosing regime and starting treatment it is most important that you:

A. cease his omeprazole
B. check his hepatic transaminase level
C. check his renal function
D. CHeck his QT interval on a resting ECG
E. Decrease his oxycodone

22. The anterior and posterior borders of the 'triangle of safety', the preferred insertion site for an intercostal catheter, are pec major and:

A. Coracobrachialis
B. Deltiod
C. Lat Dorsi
D. Serratius Anterior
E. Trapezius

[Nonum 6] With respect to the triangle of safety and intercostal chest drain (ICC) insertion, if pectoralis major and the 4th - 5th intercostal space form two borders what forms the other?

A. Latissimus dorsi
B. Serratus anterior
C. Midaxillary Line (maybe wasn't an option)
D. Posterior Axillary Line (maybe wasn't an option)
E. Trapezius

Anatomy for insertion of intercostal chest drain - triangle bordered by axilla, pectoralis major and ...?

A: Latissimus dorsi
E. Trapezius

23. A 39 yo male brought into ED with a compound fracture of his forearm. Has a history of schizophrenia and depression with nucertain medication compliance. He is confused and agitated wuth generalised rigidity but no hyperreflexi:A. Obs - HR 120, BP 160/90, RR 18, Sats 98 Temp 38.8 Likely Dx?

A. Heat stress from anticholinergics
B. Hypoxic ischaemic encephalopathy
D. Serotonin syndrome
E. Pain from fracture

24. CO2 penetrates surface tissue so well with little damage to underlying tissue becuase Well absorbed by Hb Poorly absorbed by H20 Widely disseminated in tissue Long infrared wavelength Short infrared wavelength

25. (NEW) An 80yo man is having a transuretheral bladder resection, the surgeon is using diathermy close to the lateral bladder wall which results in patient thigh adduction. The nerve involved is:

A. Inferior gluteal
B. Obturator
C. Pudendal
D. Scaitic
E. Superior gluteal

26. (New) You are involved in research and as part of data collection you collect ASA scores. This type of data is:

A. Categorical
B. Nominal
C. Non-parametric
D. Numerical
E. Ordinal

26. What best describes the type of data that ASA grading scores represent?

A. Numerical
B. Ordinal
C. Nominal
D. Ratio
E. Non-parametric

27. An otherwise healthy man presents with anaemi:A. The test that most reliably indicates iron deficiency is decreased

B. serum ferritin
C. serum iron
D. serum transferrin
E. total iron binding capacity

28. 54 year old radical prostatectomy with ongoing blood loss during the procedure. Surgeon complains of ooze and asks if the patient is on aspirin. Thromboelastograph shown below. Most appropriate therapy:

B. cryoprecipitate
D. platelets
E. tranexamic acid

Radical prostatectomy. Long operation and constant ooze. Surgeon asks if patient on 'aspirin'. You do a TEG. Shown TEG- fibrinolysis but also long r time. What treatment?

B. Cryoprecipitate
C. Desmopressin
D. Tranexamic acid

TEG, think it was picture of low fibrinogen

29. ??

30. The maximal allowable atmospheric concentration of nitrous oxide in Australian and New Zealand operating theatres (in parts per million) is

A. 5
B. 25
C. 50
D. 100
E. 200

30. Recommendation regarding safe nitrous oxide exposure in operating rooms

A. 10 ppm
B. 25 ppm
C. 50ppm
D. 100 ppm
E. 200 ppm

31. What is associated with down regulation of nicotinic acetylcholine receptors:

A. Guillain-Barre syndrome
B. Organophospate overdose
C. Spinal cord injury
D. Stroke
E. Prolonged neuromuscular blockade

31. nicotonic ach receptor downregulation, cause? A. organophosphate poisoning B. long muscle relaxant use C. ?

32. Rheumatoid arthritis. Most common C-spine abnormality is anterior subluxation. What is next most common direction of subluxation in RA

A. lateral
B. oblique
C. posterior
D. rotated
E. vertical
D. Subaxial

33. MS patient requires GA. Most likely precipitant of deterioration:

A. hyperthermia
B. hypocarbia
C. Non-depolarising muscle relaxant
E. volatile anaesthetic agent

Choice B may have been "decreased cardiac output"

34. ?

35. A reduction in DLCO can be caused by:

A. Asthma
B. Emphysema
C. Left to right shunt
D. Pulmonary haemorrhage
E. Bronchitis

36. A healthy 25 year old woman is 18 weeks pregnant. Her paternal uncle has had a confirmed episode of malignant hyperthermi:A. She has never had susceptibility testing. Her father and siblings have not been tested either. The best test to exclude malignant hyperthermia susceptibility before she delivers is

A. Genetic test father
B. Genetic test woman
C. Muscle biopsy sibling
D. Muscle biopsy father
E. Muscle biopsy woman

37. (New) The size (in French gauge) of the largest suction catheter which can be passed through a size 8 endotracheal tube which will take up not greater than half the internal diameter is size:

A. 6
B. 8
C. 10
D. 12
E. 14

37. What is the largest French gauge suction catheter whose physical diameter doesn't exceed half the internal diameter of an 8 ETT?

A. 6
B. 8
C. 10
D. 12
E. 14

37. 8.0 ETT, what french guage catheter is half the size (4, 8, 10, 12, 14)

38. (Repeat) Pneumoperitoneum cases a decrease in cardiac output at what pressure (or possibly ABOVE what pressure)

A. 10mmHg
B. 20mmHg
C. 30mmHg
D. 40mmHg
E. 50mmHg

39. 60yo male had total knee replacement. 7 days post-operatively diagnosed with deep venous thrombosis on ultrasound. Was on LMWH. PLT dropped from 300 immediately post-op and now 150x10^9/L. All the following are acceptable treatments EXCEPT-

A. Argabotran
B. Lepirudin
C. Fondapurinax
D. Danaparoid
E. Warfarin

40. [Repeat] Maximum dose (with low risk of toxicity) of lignocaine (with adrenaline 1:100000) for liposuction with tumescence technique:

A. 3 mg/kg
B. 7 mg/kg
C. 15 mg/kg
D. 25 mg/kg
E. 35 mg/kg

41. 6 year old 20kg anaesthetised and paralaysed for appendicectomy. First attempt- vocal cords seen. size 5.5 uncuffed. 2nd attempt with 4.5. Next appropriate step

A. administer nebulised adrenaline
B. attempt 4.0 tube
C. examine trachea with fibreoptic bronchoscope
E. soften 4.5 tube and attempt reinsertion

Paediatric intubation of 20kg, 5.5 doesnt fit, 4.5 doesn't fit, what next?

A. 4.0 tube
C. flex bronch
D. ?
E. ?

42. ??

43. Drug to facilitate clip placement during cerebral aneurysm surgery;

A. nimodipine
B. mannitol
C. adenosine
D. hypertonic saline
E. thiopentone

44. Which drug should be avoided both intra- and post operatively in a woman having surgery who is breast feeding a 6 week old baby?

A. codeine
B. morphine
C. paracetamol
D. parecoxib
E. tramadol

44. What is not safe to give to a breastfeeding mother during general anaesthesia?

A. Codeine
B. Morphine
C. Parecoxib
D. Tramadol
E. Paracetamol

44. Analgesia to avoid in breast feeding woman?

A. morphine
B. pethidine
C. codeine
D. parecoxib
E. tramadol

45. A three year old girl for an elective hernia repair is seen immediately prior to surgery. It is revealed she had 100mL of apple juice 2 hours ago. The best course of action is to:

A. Postpone surgery for 2 hours
B. Postpone surgery for 4 hours
C. Postpone surgery for 6 hours
D. Cancel surgery
E. Continue with surgery

[Nonum 3] A 13kg child booked for elective procedure. Has had 100mL of clear fluid 2 hours ago. Management?

A. Delay surgery for 2hours
B. Delay surgery for 4hours
C. Delay surgery for 6hours
D. Proceed with surgery
E. Cancel surgery

46. In accordance with their belief that blood transfusion is wrong, a Jehovah's Witness may consent to all of the following except:

A. Cryoprecipitate
B. Immunoglubulins
C. Fresh Frozen Plasma
D. Factor VIIa
E. Prothrombinex

47. 80 year old lady with fractured NOF needing ORIF. On examination had a systolic murmur. Arranged TTE which showed a calcific aortic valve with peak velocity of 4 m/s. Using the simplified Bernoulli equation, what is the peak pressure gradient across the valve:

A. 16 mmHg
B. 32 mmHg
C. 48 mmHg
D. 64 mmHg
E. 80 mmHg

47. AS gradient of 4m/s, what is the mean pressure using modified bernoulli (4v squared = 64)

48. You have developed a new cardiac output monitor called WaCCO. You want to compare the readings with the gold standard, a pulmonary artery catheter. What is the best statistical method to present the data/results:

A. Funnel plot
B. Bland-Altman plot
C. Forest plot
D. Galbraith plot
E. Partial regression plot

48. A new CO monitor called the WaCCO is to be implemented into clinical practice. To compare it's function to the gold standard which statistical analysis is appropriate?

A. ?
B. Bland Altman
C. Forrest Plot
D. Funnel Plot
E. Kruskal-Wallis

49. 40 year old, pulmonary artery hypertension 80/60 pre-op. Lap cholecystectomy. Sudden SPO2 87, sBP 80/40, etPCO2 45. Cause?

A. gas emboli
B. Left heart failure
C. myocardial ischaemia
D. pneumothorax
E. right heart failure

Patient with known PAH with pulmonary pressures of 80/60 undergoing a lap cholecystectomy. About 20mins into case there is a sudden acute drop in SpO2 88%, hypotension. This is most likely to be?

A. Pulmonary embolism
B. Venous air embolism
C. Acute right heart failure
D. ?
E. ?

50. A 60 year old, triple vessel disease normal LV for CABG. Post CPB, hypotensive, ST elevation II, avF, CVP 15 PCWP 25. Normal pulmonary and systemic vascular resistance. TOE will show:

A. A early diastolic mitral inflow dynamic with atrial systole
B. Left inferior hypokinesis
C. Left ventricle collapse at end systole
D. Right ventricle dilation and TR
E. Severe Mitral Regurg

A remembered as "early diastolic mitral inflow > mitral inflow during atrial systole"

51. Maximum amplitude from TEG or ROTEM decreased give

A. Cryoprecipitate
C. Platelets
D. Prothrombinex
E. Tranexamimic acid

51. With regards to ROTEM: maximal clot firmness (Increased MA: maximal amplitude on TEG) correlates best with needing to give:

B. Cryoprecipitate
C. Platelets

52. Young male, previous IVDU, now on 100mg oral Methadone per day has an emergency laparotomy with an effective epidural. Amount of IV Morphine needed per HOUR:

A. 1mg
B. 2mg
C. 4mg
D. 8mg
E. 16mg

  • I think 53 was this one, if not 53, it was definitely in the paper:

53. A healthy 25 year old woman is 18 weeks pregnant. Her paternal uncle has had a confirmed episode of malignant hyperthermi:A. She has never had susceptibility testing. Her father and siblings have not been tested either. The best test to exclude malignant hyperthermia susceptibility before she delivers is

A. Genetic test father
B. Genetic test woman
C. Muscle biopsy sibling
D. Muscle biopsy father
E. Muscle biopsy woman

54. Fluoroscopy in the operating theatre increases the exposure of theatre personnel to ionising radiation. Best method to minimise one's exposure to such radiation is to

A. have dosimeter checked at least 6-monthly
B. limit exposure time to radiation
C. maximal distance from radiation source
D. stand behind transmitter of C arm
E. wear protective garments

55. 10L/min via facemask. Cylinder C 15 000kP lasts

A. 10min
B. 15min
C. 30min
D. 45min
E. 60 min

56. 23 year old. TCA.

A. adrenaline
B. amiodarone
C. lignocaine
D. magnesium
E. phenytoin

57. Ibuprofen dose for one year old child tds regular post-op dose

A. 5mg/kg
B. 10
C. 15
D. 20
E. 25

58. AICD, what does a magnet do

A. Maintain defib activity & activate asynchronous pacing
B. maintain anti tachycardia pacing & deactivate asynchronous pacing
C. Deactivate anti tachycardia pacing & activate asynchronous pacing
D. Deactivate defib & activate asynchronous pacing
E. Deactivate defib & deactivate asynchronous pacing

59. ?To prevent transmission of CJD? Airway-contaminated equipment

A. autoclave
B. protected plastic covers
C. sterilise in ethylene oxide
D. 134degreesC for 3 min
E. thrown away

60. A 35yo man collapses in shopping mall and is resuscitated by bystanders using an AE:D. On admission to hospital his ECG was as below;

ECG - sinus, rate ~60, normal axis, borderline PR interval, RSR' in V1 and V2 with ST elevation and inverted T waves (Brugada sign)

A. Acute pericarditis
B. Brugada
C. Cocaine intoxication
D. Coronary artery spasm
E. Long QT syndrome
  • There was an ECG with definite V1-V3 Brugada Syndrome Type 1

What does the following ECG demonstrate? [ECG provided]

B. Anterior infarct
C. Digoxin toxicity
D. Brugada syndrome
E. ?

Options may be out but Brugada was definitely there.

61. A 58yo with solitary hepatic metastasis from colon cancer scheduled for resection of R lobe of liver. Inorder to manage the risk of intra-operative haemorrhage, it is most important to maintain:

A. High CVP in anticipation of heavy blood loss
B. Decreased MAP to reduce arterial bleeding
C. Decreased CVP to reduce venous bleeding
D. Normal MAP in anticipation of heavy blood loss
E. Normal CVP to ensure adequate filling of the heart.

62. ??

63. A man is admitted to ICU with a Sodium of 105 mmol/L. What is the maximum his sodium should be raised in the next 24 hours

A. 5 mmol
B. 10 mmol
C. 15 mmol
D. 20 mmol
E. 25 mmol

Impaired level of consciousness (possible seizures) on ward. Sodium concentration 105mmol/L, what is the maximum correction in 24hrs?

A. 8
B. 10
C. 12
D. 15
E. 20

64. What is the distance from lips to carina in a 70 Kg man?

A. 21 cm
B. 23 cm
C. 25 cm
D. 27 cm
E. 29cm

What is the average tube depth from lips to carina in a male? (may have said female)

A. 22
B. 25
C. 27
D. 29
E. 19

65. The action of which laryngeal laryngeal muscle opens the cords?

A. Cricothyroid
B. Posterior cricoarytenoid
C. Lateral Cricoarytenoid
D. Thyroarytenoid
E. Vocalis

66. Induction of a 4yr old child with Arthrogrophysis multiplex congenita, however you find it difficult to place the laryngoscope. What is the concern? (paraphrased question here, can’t remember all possible answers)

B. Neuroleptic malignant syndrome
C. ?
D. opioid induced rigidity
E. TMJ rigidity

([See TMP-Jul10-023 for similar/same Q )

67. ??

68. ??

69. ??

70. A patient is suffering from aortic dissection with acute aortic regurgitation. BP 160/90, HR 100 & evidence of acute pulmonary oedema. What is your immediate management?

A. Beta-blockers
B. Dopamine
C. Dobutamine
D. Sodium nitroprusside
E. Intra-aortic Balloon Pump

71. Presented are a femoral arterial line trace & a central venous line (JVP) trace - looked like it was demonstrating elevated right atrial pressures... What is demonstrated by these pressure waveforms?

A. Aortic Stenosis
B. Aortic Regurgitation
C. Pulmonary Regurgitation
D. Tricuspid Regurgitation
E. Mitral Regurgitation

71. Given the following femoral AL and CVP traces, what is the most likely cause? [diagram]

A. Pulmonary stenosis
B. Left Ventricular Failure
C. Tricuspid Regurgitation
D. Aortic Stenosis
E. Mitral Stenosis

71. Trace of an Arterial line and RA venous pressure. The venous pressure started escalating prior to the onset of the arterial pressure rise (all 4 regurg options, one stenotic option)

72. The MELD score is calculated using INR, Bilirubin & what?

A. Creatinine
B. Albumin
C. Urea
E. Ammonia

73. In resuscitating a newborn infant after delivery, the time at which you would like to achieve arterial oxygen saturation of 85-90%:

A. 2mins
B. 3mins
C. 4mins
D. 5mins
E. 10mins

73. Aim for saO2 of 85-90% in neonatal resuscitation by-

A. 1min
B. 2min
C. 3min
D. 5min
E. 10min

74. (repeat): You inserted a central venous line and peripheral arterial line for a patient who is having a tumour removed via craniotomy. The transducers of both the lines were placed at the level of the right atrium 13cm below the level of the external auditory canal. MAP is 80mmHg, CVP 5mmHg. What is the CPP?

A. 62mmHg
B. 65mmHg
C. 70mmHg
D. 75mmHg
E. 80mmHg

75. What proportion of the population are heterozygous for plasma cholinesterase deficiency?Having a Dibucaine number of 30-80.

A. 0.04
B. 0.4
C. 4
D. 14
E. 40

76. You are putting in a internal jugular central venous line. Which maneuvre causes maximal distension of the internal jugular vein?

B. Breath hold at end expiration
C. Manual compression at the base of the neck
D. Trendelenberg position
E. Valsalva manoeuvre

77. ??

78. ??

79. ??

80. ??

81. ??

82. A 40 yo woman for laparotomy to remove phaeochromocytoma under combined epidural and general anaesthesia. Pre-operatively treated with phenoxybenzamine and metoprolol. Intra-operatively, blood pressure is 250/130 despite high dose phentolamine and SNP. HR is 70/min and SaO2 are 98%. The next most appropriate treatment is:

A. Epidural Lignocaine
B. IV Esmolol
C. IV Hydralazine
D. IV Magnesium
E. IV Propofol

83. Best option to reduce risk of Ventilator induced pneumonia?

A. Nurse in supine position
B. Early spontaneous ventilation through ETT
C. Oral hygiene
D. Use antacids
E. Regularly change breathing circle

84. ?

85. A 37 year old female presents to ED with headache and confusion. She is otherwise neurological normal and haemodynamically stable. Urine catheter and bloods taken. UO > 400ml/hr for 2 consecutive hours, Serum Na 123 mmol/l, Serum Osmolality 268, Urine Osmolality. The most likely diagnosis is

A. Central diabetes insipidus
B. Nephrogenic diabetes insipidus
C. Psychogenic polydipsia
D. Cerebral salt wasting


Photograph of an Arndt bronchial blocker multiport airway adapter. Orifice labelled 'X'. What goes in 'X'?

A. Bronchoscope
B. ?
C. ?

87. ?

88. ?

89. A 63 year old woman with chronic AF has a history of HTN, T2DM and has had a previous CVS. Her annual risk of stroke without anticoagulation is

A. <1%
B. 1.9%
C. 2.8%
D. 4%
E. 8.5%

90. A previous question involving CJD. I think it was: Appropriate infection control measures when anaesthetising a patient with a suspected variant of CJD, should involve what with the airway equipment

A. Throw it away
B. Placed in a plastic sheath and re-used
C. Sterilise it with ethylene glycol
D. Sterilise it with heat at 134 degrees for 3min
E. Autoclave it

If it wasn't his one then it was the CJD ethical question

An 85y.o for an open AAA repair. Refuses blood because of risk vCJD. You tell him you won't anaesthetise him as the risk is too high. This is an example of

A. Autonomy
B. Beneficence
C. Justice
D. Coercion
E. Paternalism

91. The American Heart Association (AHA) guidelines for preoperative cardiac risk assessment define a poor functional capacity as only able to exercise at a level of less than 4 metabolic equivalents (METs). Exercise capacity of 4 METs corresponds to

A. light housework such as dishwashing
B. heavy work around the house such as moving heavy objects
C. jogging 2km
D. brisk walking on level ground (6km/hr)
E. slow walking on level ground (3km/hr)

92. Pneumoperitoneum for laparoscopy is commonly associated with each of the following EXCEPT

A. arterial pressure
B. vasopressin secretion
C. inotropic action
D. systemic vascular resistance
E. venous resistance

93. 7 year old with closed head injury. Intubated and ventilated in ICU. Serum sodium 142. Most appropriate maintenance fluid is:

A. 0.3% saline plus 3% glucose
B. 0.45% saline plus 5% glucose
C. 0.9% Saline
D. Hartman's solution
E. Hartman's plus 5% glucose

94. Patient with Marfan's syndrome. Thoracoabdominal aortic aneurysm repair. 24 hours later in ICU noted to be blood in CSF drain and patient obtunded. Most appropriate urgent management:

A. CT head
B. Coagulation screen
C. CSF culture
D. MRI brain
E. MRI spine

95. ?

96. ?

97. ?

98. ?

99. (new) The respiratory pattern most likely seen in an acute C5 spinal cord injury:

A. increased respiratory rate
B. arterial hypoxaemia
C. chest wall immobility
D. ?
E. ?

100. (new) Afterload reduction is most useful in which of the following:

A. ?
B. ?
C. Tetralogy of Fallot
D. mitral valve incompetence
E. aortic valve incompetence

100. something about pharmacologically induced reduction in afterload (? which condition would not benefit from this)

A. aortic stenosis
B. tetralogy of fallot
C. cardiac tamponade
D. Mitral incompetence
E. aortic incompetence

101. TMP-Jul10-044 A 20 year old man was punched in the throat 3 hours ago at a party. He is now complaining of severe pain, difficulty swallowing, has a hoarse voice and had has some haemoptysis. What is your next step in his management?

A. Awake Fibreoptic Intubation
B. CT scan for laryngeal fractures
C. Direct laryngoscopy after topicalising with local anaesthetic
D. Nasopharyngoscopy by an ENT surgeon
E. Soft tissue xray of the neck

102. Preferred method for treating raised INR

B. FFP + prothrombinex
C. FFP + vitamin K
D. prothrombinex
E. prothrombinex + vitamin K

103. Regarding PS31, Level II check includes:

(Multiple options, can’t remember exactly)

104. Anaphylaxis, when to check tryptase

A. Within 15 minutes of event
B. Between 1 hour and 3 hour
C. Between 4 hour and 6 hour
D. Between 6 hour and 12 hour
E. After 24 hour

105. ?

106. ?

107. [New] A 53 yo man with severe Parkinson’s Disease is scheduled for L) Total shoulder arthroplasty. He has a Deep Brain Stimulator (DBS) in situ which is functioning normally. On the day of surgery, optimal management is to:

A. ensure placement of the diathermy return pad to direct current spread away from the DBS
B. leave the DBS as it can safely be left activated throughout surgery.
C. turn off the DBS and cover with oral levodopa
D. turn off the DBS for the duration of surgery but reactivate prior to emergence from anaesthesia.
E. use bipolar diathermy as it’s the only safe option

108. (New) A postpartum woman presents with numbness over posterior thigh, lateral leg and foot. There is weakness on flexion of the knee. An epidural was sited for labour and she underwent an instrumental delivery. The most likely site of the injury is

A. Femoral neve
B. Lateral femoral cutaneous nerve.
C. Lumbosacral plexus
D. Obturator nerve
E. Sciatic nerve

109 Patient with metastatic cancer. What's not useful to increase Ca excretion?

A. Bisphosphonates.
B. ?

110. (New, long stem taking up half the page) Male in 60's one day post laparotomy. Management includes: IVH @40ml/hr, 2L oxygen via nasal prongs, and a morphine PCA. Observations: t38.8C, RR14, Sats 88% Examination: mildly sedated, bibasal creps. In addition to increasing the FiO2 what would be your initial management?

A. Incentive spirometry
B. Diuresis
C. Broad spectrum ABs
D. Naloxone 100mcg increments
E. ?

111. A patient is coming for an operation on his upper limb. 5mls of 0.75% ropivacaine is placed around the structure seen below. What is the most likely consequence of this?

A. Unable to abduct fingers
B. Unable to extend wrist
C. Unable to oppose little finger and thumb
D. Unable to pronate arm
E. Unable to [unsure of 5th option]

[Also please note that the picture was very poorly produced. You could make out a triangle structure and the humerus but nothing else]

112. A 40 year old man suffered a traumatic brain injury 2 days ago. He does not meet the criteria to be certified brain dead. What investigation will be most useful to assess cerbral function prior to organ donation.

A. Electroencephalogram
B. Somatosensory evoked potentials
C. Auditory evoked potentials
D. Motor evoked potentials

113. EV02 Isoflurane is administered in a hyperbaric chamber at 3 atmospheres using a variable bypass vapouriser, at a constant fresh gas flow and vapour dial setting, the vapour produced will be:

A the indicated vapour concentration
B three times the indicated vapour concentration
C one third the partial pressure obtained at 1 atmosphere
D the same partial pressure as is obtained at 1 atmosphere
E three times the partial pressure obtained at 1 atmosphere

114. What is most likely to occur if the earth/grounding plate that is attached to a patient for use with monopolar diathermy malfunctions?

A electrocution
B electrical interference with monitors
C electrical burns
D ignition of gases/volatiles
E microshock

115. A 24yo primigravida, 25/40 gestation, BP 150/90 on 4 occasions. No signs of pre-eclampsia. Which antihypertensive is inappropriate?

A. diazoxide
B. metoprolol
C. enalapril
D. hydralazine
E. nifedipine

116. Post-spinal surgery, patient notices paraesthesia of R arm, surgeon thinks this is an ulnar nerve palsy due to poor positioning. What sign will distinguish a C8-T1 nerve root lesion from ulnar nerve neuropathy?

A. paraesthesia in little finger
B. paraesthesia in the distribution of the interscalene nerve
C. weakness in adductor digiti minimi
D. weakness in the abductor pollicis brevis
E. weakness in lateral interosseus

117. ?

118. ?

119. According to PS09, the minimum requirement for administering propofol for conscious sedation is

A. Medical practitioner with a skilled assistant that is seperate from the assistant to the proceduralist
B. Medical practitioner
C. Nurse supervised by proceduralist with recent ALS training
D. Specialist anaesthetist
E. Nurse with advanced airway skills

119. According to PS09 professional document which is most correct with respect to the minimum requirements for propofol anaesthesia in the endoscopy suite?

A. Medical practitioner and a qualified assistant in anaesthesia
B. Medical Practitioner
D. RN with airway skills
E. Clinical Anaesthetic Specialist

PS09 pp8: "Intravenous anaesthetic agents such as propofol must only be used by a second medical or dental practitioner trained in their use because of the risk of unintentional loss of consciousness. These agents must not be administered by the proceduralist." But also see Scenario 2 of Appendix 1 of PS09: the assistant can be shared between both ends for conscious sedation in ASA 1-2 patients only. Therefore best answer would be a medical or dental practitioner trained in its use with an assistant who may be shared with the proceeduralist. --Farnsworth 06:17, 8 June 2014 (CDT)

120. ?

121. ?

122. Reasons infants desaturate faster than adults on induction (?did it say rapid sequence?)

A. More difficult to preoxygenate
B. More rapid detection of hypoxia
C. FRC decreased more than adults
D. Drugs work more rapidly
E. Persistent L->R shunt (or was it right to left?)

123.  ?

124.  ?

125. Adenosine can be used to treat

A. Atrial fibrillation
B. Atrial flutter with variable block
C. WPW syndrome
D. Ventricular tachycardia
E. Torsades

125. Adenosine would be useful for terminating which arrhythmia?

B. Atrial Flutter with variable block
C. Torsades

126. Induction with thio 5mg/kg, scoline 2mg/kg, Difficult to open mouth, Finally intubated. Next step

A. Continue surgery with tiva propofol
B. Abandon surgery
C. Wait for co2 to rise restart surgery after 30 min
D. Continue with inhalational agents
E. Give calcium as potassium may have raised.

  • I think 127 was actually a repeat: SZ20:

127. In a patient with an intra-orbital haemorrhage, following local anaesthetic injection, the adequacy of ocular perfusion is best assessed by

A. angiography
B. direct ophthalmoscopy
C. indirect ophthalmoscopy
D. intra-ocular pressure tonometry
E. palpation of the globe by an experienced clinician

128. A patient is in Class IV Haemorrhagic Shock, secondary to a gunshot wound to the abdomen. He is clinically coagulopathic 30 minutes later. He has received intravenous Hartmann's 1L. The coagulopathy is likely related to:

A. acidosis
B. dilution of clotting factors
C. hypothermia
D. systemic release of tissue factor
E. tissue hypoperfusion

128. A 28 year old male in class IV hypovolaemic shock following a thoracic gunshot sustained 30/60 ago has received 1.0 litre CSL and is oozing. Which contributes most to his coagulopathy?

A. Acidosis
B. Dilutional coagulopathy
C. Hypothermia
D. Clotting factor deficiency/utilisation
E. Fibrinolysis (maybe not there)

For 128 on coagulopathy in trauma, I think the last two options were

D. massive release of tissue factor due to tissue damage
E. organ hypo perfusion

Fibrionolysis definitely wasn't there and I don't think clotting factor consumption was either.

129. (Repeat SG47) A 20 kilogram child suffered 15% full thickness burns 6 hours ago. Optimum crystalloid resuscitation for the first hour is:

A. 160ml
B. 260ml
C. 360ml
D. 460ml
E. 660ml

130. You’re anaesthetizing an otherwise well 40 yo male for a craniotomy. Propofol and remifentanil TIVA. Using entropy. The MAP is 70 mmHg, heart rate is 70 bpm, Sats are 98%, state entropy is 50 and the response entropy 70. Most appropriate next step is

A. give 0.5 mg metaraminol iv
B. use NMT to assess train of four ratio
C. change to volatile anaesthetic
D. do nothing
E. increase propofol TCI concentration by 0.5

131. AZ75 The normal physiological response following ECT is

A. transient tachycardia followed by bradycardia and hypotension
B. transient bradycardia followed by tachycardia and hypertension
C. unpredictable
D. transient tachycardia followed by bradycardia and hypertension
E. tachycardia and hypotension

131 AZ75 Haemodynamic changes that occur with ECT are best described as:

A. Unpredictable
B. Initial tachycardia
C. Initial tachycardia followed by bradycardia and hypotension
D. Initial bradycardia
E. Initial bradycardia followed by tachycardia and hypertension

132 (repeat) ->also recalled as Q148 so one must be a mistake –see below Aspirin Overdose. What will enhance her elimination most effectively?

A. Mannitol
B. Haemodialysis
C. lignocaine
D. ?
E. BIcarbonate infusion

133. A 50 year old male is having an aortic valve replacement for aortic stenosis. He is stable on bypass initially but after the first dose of cardioplegia his MAP falls to 25mmHg, CVP 1 and his mixed venous oxygen saturation is 80%. What is the best management in this situation.

A. Metaraminol bolus
B. Commence an adrenaline infusion
C. Increase oxygen flow rate
D. Increase pump flow rate
E. IV crystalloid bolus

134. An eighty year old man presents to the emergency department with two hours of severe abdominal pain. On examination he has a tender pulsatile 8cm mass. His GCS is 12, heart rate 104, blood pressure 80/49, Temp 35 degrees, SpO2 92%, respiratory rate is 30/min. What is the next appropriate step.

A. Commence a vassopressor to support the circulation and improve end organ perfusion.
B. Obtain IV access and crossmatch
C. Intubate to secure the airway and prevent aspiration
D. Perform an abdominal ultrasound to confirm diagnosis
E. Ventilate with a bag valve mask to improve saturations

135. ?

136. ?

137. A PiCCO monitor may be used to measure cardiac output through use of:

A. Lithium Dilution Cardiac Output (LiDCO)
B. Pulse contour analysis
C. Pulse contour analysis and thermodilution
D. Thermodilution
E. Thermodilution and aortic flow doppler

138. A tablet containing OxyContin 40mg and naloxone 20mg offers the following advantage over OxyContin alone.

A. Less potential for abuse
B. Less constipation
C. Less sedation
D. Less respiratory depression
E. Less pruritus

139. ?

140. ?

141. Immunity to Hepatitis B is demonstrated by the presence of

A. Hepatits B core antibodies
B. Hepatits B core antigens
C. Hepatits B surface antibodies
D. Hepatits B surface antigens
E. Any of the above

142. In an adult with advanced liver cirrhosis, the best predictor of bleeding is

A. Dysfibrinogenaemia
B. Hypoalbuminaemia
C. Prolonged Prothrombin time
D. Portal Hypertension
E. Thrombocytopaenia

143. 65 year old lady with acute cholecystitis presenting for cholecystectomy. Has known hyperparathyroidism. Calcium 2.2mmol/L (normal values given). Initial treatment with:

A. calcitonin
B. frusemide
C. intravenous fluids
D. magnesium
E. mythramycin

144. SG67 20 year old male 80kg presents post house fire with 30% burns. Using the Parkland formula how much fluid should he have replaced in the first 8 hours.

A. 2.6L N/saline
B. 3.6L N/saline
C. 3.6L CSL
D. 4.8L N/saline
E. 4.8L CSL

145 The thoracic paravertebral space is continuous down to

A. T10
B. T12
C. L2
D. L4
E. S1

146. To best visualise a superficial peripheral nerve you should use a

A. low frequency probe at 90 degrees to the skin
B. high frequency probe at 90 degrees to the skin
C. low frequency probe at 45 degrees to the skin
D. high frequency probe at 45 degrees to the skin
E. low frequency probe at 75 degrees to the skin

147. ?

148: (Repeat). After ingestion of 500mg/kg aspirin, the most efficient therapy to enhance the elimination is

A. normal saline infusion
B. bicarbonate infusion
C. mannitol
D. frusemide
E. haemodialysis

149 (?repeat -not sure) You have administered a regional anaesthetic to a primiparous woman for an emergency caesarean section. Soon after delivery of the baby, the woman complains of chest pain and dyspnoea, then loses consciousness. What is the most likely cause of her loss of consciousness?

A. Administration of suxamethonium
B. Anaphylaxis to oxytocin
C. Amniotic fluid embolus
D. Pulmonary Embolus
E. Eclamptic seizure

After an uneventful Caesarean section under regional anaesthesia a healthy primigravida complains of chest pain and shortness of breath before rapidly losing consciousness. What is the most likely cause?

A. Inadvertent administration of suxamethonium
B. Pulmonary embolism
C. Amniotic fluid embolism
D. Anaphylaxis to oxytocin
E. Venous air embolism

150. The faster rate to desaturation observed in morbidly obese patients is due to:

A. Decreased residual volume
B. Decreased functional residual capacity
C. Decreased diffusion capacity
D. Increased closing capacity
E. Increased pulmonary blood volume

Questions remembered but number not recalled

Some of the MCQs originally posted below have been recognised as MCQs listed in the numbered section,
so they have been moved there. 
This is why some numbers are missing below.

[Nonum 1] In preadmission clinic with patient with a tracheostomy. To enable patient to talk you would-

A. Deflate tracheostomy cuff, insert one-way valve, insert fenestrated piece
B. Deflate tracheostomy cuff, remove one-way valve, insert fenestrated piece
C. Inflate tracheostomy cuff, remove one-way valve, insert fenestrated piece
D. Inflate tracheostomy cuff, insert one-way valve, insert fenestrated piece
E. ?

(Alt:Tracheostomy in situ in patient in outpatient clinic, what to do to enable patient to speak (each choice had three components, I think the answer was cuff down, festrated insert, one way valve but don't quote me on it)

[Nonum 5] Which is least likely to fraudulent research reduction strategy?

A. Published in a peer review journal
B. Multiple authors
C. Departmental director sole author
D. Research findings similar to other published studies
E. Backing of a major research institute

[Nonum 7] Small picture trying to show USS probe on inferio-posterior R arm of a teenager's arm with an associated USS image of a very triangular looking peripheral nerve between two muscle fascia (radial N).

Blockade of this nerve would result in?

A. Reduced pronation
B. Reduced hand grip.
C. Reduced elbow flexion
D. Reduced wrist extension
E. ?

Alt: US picture of radial nerve at upper arm, which motion blocked (wrist extension, pronation)

Alt: Picture showing USS probe in the lower lateral arm near elbow (ie radial nerve) - nerve block confirmed by?

A. Thumb adduction
B. Pronation

[Nonum 8] USS picture of an axillary brachial plexus nerve block with all four nerve unlabelled, the humerus, brachioradialis and biceps brachii marked.

(Good quality image provided)

What is the structure labelled 1.?

A. Musculocutaneous nerve (answer)
B. was Radial N
C. was Ulnar N
D. was Median N

[Nonum 11] Trauma patient undergoes delayed ORIF tibia. Induction consists of suxamethonium, propofol and an ETT. Cephalozin is given and rocuronium also given (long stem to confuse us). Suddenly bradycardic, ETCO2 45, MAP 50mmHg. This is most likely to be ..?

B. Fat embolism
C. Anaphylaxis
D. ?
E. ?

Alt version: Above also remembered as:

Trauma patient undergoes delayed ORIF FEMUR. Induction consists of suxamethonium, propofol and an ETT. Cephalozin is given and rocuronium Femoral Nerve Block, turned lateral. Suddenly BRADYCARDIC, ETCO2 45, MAP 50mmHg. This is most likely to be ..?

B. Fat embolism
C. Anaphylaxis
D. LA Toxicity
E. ?
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